title: Infections increase the risk of central venous catheter-related thrombosis in adult acute myeloid leukemia.
abstract: BACKGROUND
  Central venous catheters (CVC) related thrombosis (CRT) represents a well known complication in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy but the efficacy of antithrombotic prophylaxis still remains controversial.
  
  
  METHODS
  We analyzed 71 consecutive AML patients whose CVC was inserted before each chemotherapy cycle for an overall number of 106 CVC placements. In 47/106 insertions, a prophylaxis with 100 IU/kg/day low molecular weight heparin (LMWH) was administered for 7 days after CVC insertion and additional 7 after CVC removal. This unconventional dose of LMWH, although higher than usual, appeared adequate for a short-course approach. LMWH was delivered regardless of the platelet (PLT) count once provided that it should have been maintained above 20 x 10(9)/L by transfusions.
  
  
  RESULTS
  Of 106 insertions, we observed 19 (18%) episodes of CRT, 58 (54%) of sepsis and 50 (47%) infections of CVC-exit site with no difference between LMWH and no-LMWH group. Occurrence of CRT was significantly associated with CVC-exit site infections (14/19, p=0.01) and sepsis (16/19, p=0.005) with no difference between LMWH and no-LMWH group. In multivariate analysis, both CVC-exit site infections and sepsis were confirmed to be independent risk factors for CRT development.
  
  
  CONCLUSIONS
  Our retrospective study, although based on a small sample size, suggests that the occurrence of CVC-exit site infections and neutropenic sepsis following chemotherapy significantly increases the risk of CRT in AML, independently from the use of LMWH prophylaxis.
authors.affiliation: Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia. Electronic address: Del.Principe@Med.uniroma2.it.
authors.forename: Maria Ilaria
authors.initials: MI
authors.lastname: Del Principe
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Luca
authors.initials: L
authors.lastname: Maurillo
authors.forename: Daniela
authors.initials: D
authors.lastname: Venditti
authors.forename: Mariagiovanna
authors.initials: M
authors.lastname: Cefalo
authors.forename: Chiara
authors.initials: C
authors.lastname: Sarlo
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Caprio
authors.forename: Ambra
authors.initials: A
authors.lastname: Di Veroli
authors.forename: Daniela
authors.initials: D
authors.lastname: Nasso
authors.forename: Eleonora
authors.initials: E
authors.lastname: Ceresoli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Postorino
authors.forename: Fabio
authors.initials: F
authors.lastname: Di Piazza
authors.forename: Giulio
authors.initials: G
authors.lastname: Colandrea
authors.forename: Fabio
authors.initials: F
authors.lastname: Conti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Del Poeta
authors.forename: Sergio
authors.initials: S
authors.lastname: Amadori
authors.forename: Adriano
authors.initials: A
authors.lastname: Venditti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: AML; Acute myeloid leukemia; CRT; CVC; Catheters-related thrombosis; Central venous catheters; Central venous catheters related thrombosis; DVT; Exit-site infection; G-CSF; Heparin prophylaxis; LMWH; MTHFR; PE; PICC; PLT; PN; SVC; Sepsis; TF; Thrombocytopenia; VTE; WBC; acute myeloid leukemia; deep vein thrombosis; granulocyte cell stimulating factors; low molecular weight heparin; methylentetrahydrofolatereductase; non-tunneled subclavian venous catheter; parenteral nutrition; peripherally inserted central-venous catheter; platelet; pulmonary embolism; tissue factor; venous thromboembolism; white blood cell